Development of novel therapies aimed at reducing the mortality in acute lung injury requires an understanding of the independent risk factors for death. The majority of reported risk factors for death in acute lung injury derive from patients cared for in academic medical centers despite the fact that most acute lung injury patients are cared for in the community. Better characterization of the predictors of death can also facilitate quantification of an acute lung injury patient's severity of illness allowing investigators to improve risk-adjustment and stratification when performing observation studies and clinical trials in acute lung injury. The aims of this proposal are: 1) to identify predictors of mortality in a population-based cohort of patients with acute lung injury, 2) to develop and validate a population-based severity-of-illness measure for acute lung injury, and 3) to compare the acute lung injury specific severity-of-illness measure's ability to discriminate death to that of currently available generic severity-of-illness measures. These aims will be achieved by conducting a secondary analysis of the King County Lung Injury Project (KCLIP). KCLIP is a large, prospective population-based cohort of patients with acute lung injury from King County, Washington incorporating patients cared for predominantly in community hospitals. Acute lung injury specific variables as well as variables previously shown to predict death in general ICU patients, will be evaluated for their association with death at hospital discharge. Those significant will be entered into a multivariable logistic regression equation to generate a novel severity-of-illness model. After validation in an independent patient cohort the performance of this model will be compared to that of existing severity-of-illness measures. Relevance: Despite advances in critical care, acute lung injury remains a significant public health burden killing approximately 75,000 patients each year in the United States alone. The proposed study will provide new knowledge about the predictors of mortality in acute lung injury cared for in the community with the long term goal of facilitating severity-of-illness measurement and identifying potential therapeutic targets for acute lung injury treatment. [unreadable] [unreadable] [unreadable] [unreadable]